Cultural Humility through Public Health 
[00:00:00] Announcer: Welcome to SLP Learning Series, a podcast series presented by SpeechTherapyPD. com. The SLP Learning Series explores various topics of speech language pathology. Each season dives deeper into a topic with a different host and guests who are leaders in the field. Some topics include stuttering, AAC, sports concussion, Teletherapy ethics and more.
[00:00:42] Each episode has an accompanying audio course on speech therapy pd.com and is available for 0.1 ASHA. CEUs now come along with us as we look closer into the many topics of speech language pathology. 
[00:01:04] Treasyri: Hello. Hello, everyone. Welcome back for episode two of culturally speeching cultural competence through cultural humility. I am your host, Dr. Treasyri Williams Wood. And this series is a mini series being presented to you from speechtherapypd.com thank you so much for joining us for our second episode. And this episode is called Cultural Humility Through Public Health.
[00:01:38] Now this episode is offered for 0. 1 ASHA CEUs. And again, I am your host, Dr. Treasyri Williams Wood. I am a speech language pathologist and clinical researcher, as well as a private practice owner. And I am coming to you live from the South side of Chicago. Here are the financials and non financial disclosures.
[00:02:02] So again, I'm the host of this podcast. I receive compensation from speechtherapypd. com and I am the CEO and founder of Willwood Consulting Services, PLOC in Chicago. My name. Financial disclosures are I am serving as the member at large and speech language pathology for the American speech and hearing associations.
[00:02:25] I also serve on the legislative and regulation committee for the Illinois speech and hearing association. Our guest today. Pamela Rowe is the clinic director of Pamela Rowe, MA, CCC-SLP, LLC which is an adult and pediatric therapy practice with seven locations, not one, not two, not three, not four, not five, not six, but seven locations that provide speech, occupational, physical, and respiratory therapy services.
[00:02:59] Now, as if she didn't have enough to do with her seven locations, she is also a student in the University of Indianapolis, Doctor of Health Sciences and Master of Public Health Programs. She is co author of Putting Your Dreams to Work. Keys to setting up your therapy practice and, and start your engines, a roadmap to your clinical fellowship year.
[00:03:26] As a continuing partner with various state agencies, Pamela enjoys empowering individuals to communicate and use their voices within the community. And she is an incredible speaker. So if you have an event that you're, that you need a speaker for, I always highly recommend Pamela. Pamela receives an honorarium for speechtherapypd.
[00:03:46] com for this episode. And is obviously the CEO of her practice, her non financial disclosures are, she is a member of the National Black Association of Speech, Language, and Hearing and in Basel's GAP committee and partnerships committee. She's also a member of the Society of Public Health Education SOPHI National and Florida Chapters and the American Public Health Association.
[00:04:11] We have the right person in the room today as we talk about how we can learn and foster cultural humility through public health. So first of all, after I just said that mouthful, I want to welcome you to episode two. Well, look, I made a rhyme. I'm really on fire today. Hey, we're doing it. I love it. I love it.
[00:04:35] We're ready. When, when Pam and I get together, usually we are both very highly caffeinated. So we just apologize in advance. She's probably one of the few colleagues that I have that can match my level of caffeinated insanity and still make sense. Hopefully we'll, we'll be making sense still by the end of this podcast.
[00:04:55] We'll see, we know you all never hold your punches with feedback. So, you know, just. Just be gentle with us because we tend to have a lot of fun when we get together. It's been such a pleasure throughout my career, just watching you grow into this public health sector and becoming such an incredible advocate for tying public health and health disparities to the work we do and speech language pathology.
[00:05:20] And so I would just. Just, you know, just to start off, I just am so curious can you first just tell us about your journey as a speech language pathologist and tell us about what led you down the path of you know, of public to public health and getting this doctorate in health sciences and the master's degree in public health.
[00:05:42] Pamela: Absolutely. Well, hello everyone. As you know, my name is Pamela Rowe, speech language pathologist. I can't not say the whole thing at this point. I started out working in the school system, and I'm telling you I was making $21,000 a year and you could not tell me anything . I was bachelor. Listen, I was a bachelor level clinician.
[00:06:05] I I started out in the field, loved it, loved it, loved it. And it was never a question for me. I knew I wanted to be a speech therapist since ninth grade. So it never was a question that I wouldn't get my bachelor's in communication disorders and then get my master's. And But something kind of happened my late husband he did recommend to me, hey, you know what, you should, you should open up your practice.
[00:06:30] I told my employer, right, at Jeff Herman, if anybody knows Orlando and he gave me, My, my first patients, basically, he's like, I, I really think you should. You had that area, you know? So, that's where I started. I started in Pine Hills area serving in that area in daycares and homes. And the area, yes.
[00:06:56] The area where there's lower socioeconomic neighborhoods and families, so that's. It's been my practice. That's what we never had a cap was very, very popular, very popular. When I started my practice, do you have a cap? On the amount of Medicaid patients that you would take. And maybe I was just too silly to know.
[00:07:16] That's not what you do, but that's not what I wanted to do. So we've always endeavored to be in the community and serve the community. And so I've been doing that since 2002, when I first Hung my shingle. I feel like there's been a lot of research. I've done a lot of research, you know, really delved in and I was doing research with one of my colleagues, Dr.
[00:07:39] Kelly Utenham. And in the middle of our conversation where we are vibing, I mean, we're like, Oh yeah, we're going to do this and this and this. And I was like, I need to go back to school and get my doctorate. And she's like, Yeah. 
[00:07:55] Treasyri: Only two sick minds could go. Let's go back to school. Yes. 
[00:07:59] Pamela: Yes, yes, so anyway, I, I decided I was going to get my doctorate in health sciences.
[00:08:05] And then I took a class my first semester in health disparities. And I was like, this is it. So I decided to get that dual dual degree in public health. And that really, It is the overarching thing of what I want to do. My main areas that I want to do research in have to do with surrounding and wraparound services for families that are along the justice system continuum.
[00:08:31] Mm hmm. Mm hmm. Our mothers and our fathers that have gone through incarceration and all the possible research and wraparound that we can get get around our families and support them. So that's, that's what I'm all about. It's exciting. 
[00:08:48] Treasyri: Like so much that was like what I call it everything burger where it was like all the things, right?
[00:08:54] That's everything burger. It was so a couple of things that you said that just really resonated with me. First of all the first is this idea that you went into your business without a cap. Right. And I think that as speech language pathologists and just in general, right. As healthcare professionals, we're almost subconsciously conditioned to believe that treating the poor and that having treating pub people on public assistance, or that opening our practices and opening our doors to is bad for business.
[00:09:27] And so I think I just want to kind of highlight that and long your journey as a person who is in the state of Florida, who started off. Never having a cap really not even not because it was a strategic business decision, but because you just didn't know any better. You were that green, right? Which is just I just love, you know, I love the Lord.
[00:09:49] So I always say that's just God right there, right? Yeah. Because you were just green and you did, you didn't know any better. You naturally just went in and said, okay, well, as a healthcare provider, I'm going to provide healthcare services. And now look at you now over two decades later, almost right. More than two decades, right.
[00:10:09] SpeechPath, don't do that, you have over almost seven locations and probably could easily open up more. Right. And have this has not been an issue. So I just love that you brought that up because I know a lot of folks in private practice and even a lot of people that are looking to enter the workforce are often like, oh, man, this is a Medicaid facility or, oh, man, if I take Medicaid, I'm not going to be able to eat.
[00:10:34] I won't be able to feed myself. And that's simply not true. Right. And so. As we get into this, I really want to kind of, I want to give you an opportunity to tell us about that. Like, tell us more about how, when, you know, you started your business, how, what kind of public health challenges did you have to address?
[00:10:57] What, what were some things that were blaring and just how did you, from a practitioner level, go about addressing those in your early years? 
[00:11:05] Pamela: Yeah. So I had to address a lot of public health issues. I didn't have a name for it, but I was doing it. You know how you just do something and... 
[00:11:13] Treasyri: Didn't have names for a lot back then.
[00:11:14] Like, my students say stuff like, Oh, I'm gas lit and I'm triggered. I was like, I didn't have words for that. It was just like, I was just stressed. I just ate. I just ate my feelings. I didn't know. I look like they have this vocabulary for these things now 
[00:11:29] Pamela: Because And that, okay, good for the specificity of the vocabulary, but we didn't have imposter syndrome.
[00:11:37] I had doubt, but guess what? Still had to do the doggone thing. And I didn't have time to like, you know, yeah, we just didn't know. Didn't know. So with public health the way I saw that, it showed up in my private practice and also working in the school system there's so many areas of public health.
[00:11:55] So like we're talking about environmental health, environmental justice health policy management, community health, epidemiology, global health. Safety, biostats, maternal and child health. Right. Health administration, health equity, the, the systems, all the system vaccination, oral health, all of those areas we, we are dealing with, we are dealing with the.
[00:12:22] end result of a lot of those when your caseload comes to you or you're in the school system and you're working with Children. And you're working with individuals that don't have access to insurance or they're in that weird middle gap between Medicaid eligibility and now they got to get on the Marketplace and they gotta start paying out of pocket.
[00:12:46] But parents don't have money left over for paying out of pocket. And then on top of that, they've gotta pay, you know, a deductible or a copay. When you have those middle areas of lack of access and health disparities, you see it, you see it in your the result of that in your caseload. So it's something that we all deal with and we're dealing with it on the backend, however.
[00:13:10] It's so crazy that SLPs are not really influential in policy initiation in getting in there in public health like we should all be in there, not on the receiving end, and not on the defensive end, we need to be in the forefront in the offensive end, making those changes at the forefront. 
[00:13:32] Treasyri: Yeah, leading.
[00:13:33] Because we're so, yeah, we're so uniquely positioned. We're so...
[00:13:37] Pamela: we are...
[00:13:38] Treasyri: ...we're truly a speech language pathologist. I'm an audiologist. We're positioned right at that intersection of, you know, social work, connection and community engagement and healthcare, right? Yes. We spend way more time with a patient or a client than the physician does, right?
[00:13:56] But we are, and we are evidence based practice. In motion constantly. So my first question for you is how does cultural humility different from cultural competence? And why is it particularly important in public health and communicative sciences? 
[00:14:14] Pamela: Well, I always like to think of cultural competence as a little outdated.
[00:14:20] It's very outdated. Okay, we're talking, we're talking about the 90s and the 2000s. 
[00:14:25] Treasyri: Yeah, yeah, yeah. 
[00:14:29] Pamela: We're talking that. We're talking about the 80s. That's what we're talking about. We're talking about cultural competence. It's like checking off. Okay. Today in our our, our workshop, we learned about Hispanic, right?
[00:14:46] And it's always these crazy generalizations that now we know it's not just a checkbox. It's there's no way that it's just a workshop. It's not putting everybody in a box. You can have. 10 different families of various backgrounds of Chinese American families, and you're going to have 10 different cultures.
[00:15:10] You really are. So cultural humility is first. Which I love taking inventory of your own intersectionalism, taking inventory of your own negative biases and your, your beliefs and your thoughts. So it starts with you, not just an outward work, but let's get, let's get some self awareness, what's going on here first.
[00:15:31] And then, It's being open to learning about other cultures and it's a dynamic ongoing. There's no box to check there. There could never be a box to check because you're never going to reach the end of it. And it's, it's really more engaging and it's more intentional.
[00:15:56] Treasyri: Yeah, that's what I'm hearing from you is that intrinsic focus that intrinsic, whereas cultural competence kind of is more virtue signaling, right? It's a check. It's a bad, you know, I kind of looked at it as it's a badge, right? Where's my certificate? Where's my certificate? Where's my check? Where's my standard that I met?
[00:16:15] Where's cultural humility is truly a personal journey and intrinsically focused journey that we all commit to that. It's a continuum. I love it. And so can you provide some examples of how cultural humility has been successfully applied in public health initiatives, right? We always hear about. How it has been unsuccessfully applied and what people got wrong, but I'm interested in hearing from you.
[00:16:39] Are there any cases where you look at public health initiatives and go, Ooh, they really got that right?
[00:16:44] Pamela: I can think of many. So, let's start with initiatives of research, you know, so in the research realm where now, We have more and more individuals that are saying, you know what? When you start with research in a community, you're going to there's different things you need to do.
[00:17:03] You need to reach out to your community stakeholders. You need to establish a community presence. You need to share the information afterwards. You need to disseminate the information afterwards. So all of those supports for, for empowering the community that are now. best practices. Those have changed the way that research is being done and it's also bringing in more and more diversification at much needed diversification.
[00:17:38] And it's also starting to increase medical trust, which is abysmal in many of our communities. And, and rightly so. So it's, A lot of these, the way that we're looking at incorporating and thinking about cultural responsiveness and also you know, cultural humility and the way that we're looking, the lens that we're looking through, it is changing the face of the way that we do things and, and the way we're able to move research forward, which impact practice.
[00:18:12] Treasyri: I love that. And one of the things that you said, you said a couple of things that really resonated with me, right? You talked about that medical mistrust and you you touched on research, you know, research had still has, but, you know, really, I want to say maybe probably 10 years ago, really had to confront this, this, this stark reality that people of color and people from marginalized communities, like We're not going to participate in research that was moving forward you know, really, really big diseases, right?
[00:18:45] That, you know, these minoritized communities were overrepresented in the incidents and prevalence of diabetes, of hypertension, of stroke, of dementia, of mental health issues, right? Right? Right? But then underrepresented in the research, and you had all of these researchers who, you know, went to school and wanted to do these projects.
[00:19:08] But because of, like you said, this generational history of medical mistrust that was well earned, right. And I'll let you guys Google that that timeline that people from my Northeast community said, no, we are not going to participate. We're not going to donate our brains to your Alzheimer's research.
[00:19:27] Thank you very much. We're not going to sit in our folk, your focus group. We're not going to let you treat us like guinea pigs. Cause we've seen in the past when you came into my grandmother's community, or when you came into my community as a kid, you came into the community, you got what you needed and you just kind of dumped us.
[00:19:45] Right. And so what you're talking about is that mindset shift where these researchers, right, the research community had to say, okay, We are, we have a public health crisis because we don't know. We have this small sample size of, you know, you know, this heteronormative sample size of folks that we are making pharmacological practices on.
[00:20:09] We're developing drugs based on people we're not seeing, right? These, these drugs are being developed on one type of person. It's usually an old white man or an old white woman, but then we're only seeing. Young black women with fibroids or young black people with, you know, with, with sickle cell or something like that.
[00:20:28] And so to your point, they began to make this shift and understand that it's really about relationship. And I use, I say this quote all the time. It'll probably be on my headstone. If people don't think you care, they will not care what you think. Right. So. Comment if you and I think this can really be applied right to the speech language pathologist, right?
[00:20:50] Because I think that we are obviously a profession that is 98 percent women, 93 percent white, right? And we come in to these communities of color, these communities where they're very culturally diverse, like we are doing them a favor. to work in a hospital. They're blocked. Why don't you want to come to therapy?
[00:21:14] Why don't you want to cooperate? So, you know, I guess my follow up to that is specifically, what do you think are some common challenges that practitioners like our special piece face when striving to implement that cultural humility? 
[00:21:29] Pamela: Well, I'm going to give you three things. Definitely a lack of self awareness because you're not going to have any, you know, You're not going to have any cultural humility if you haven't taken that first inventory of yourself, you don't have that awareness.
[00:21:42] Like if you think I'm all good and I don't have any biases, I have biases. I have a lot of biases. You know why? Cause I even have privilege and I know the areas that I have privilege, right? I know the places I have privilege and also I think a spirit of complacency, just thinking. But that's another barrier for implementing cultural humility, another area would just be a lack of knowledge and so one area I'll, I'll give you.
[00:22:13] For instance, 1 area of public health that people don't think of is environmental health. They don't also think about environmental justice. They don't think about another important area, which is had it written down, job safety and job help. These are some things for, like, what does that have each therapy?
[00:22:32] What is the environment have to do with speech therapy? Well, when we go into neighborhoods. Sometimes we look at those neighborhoods and we make these assumptions about How did the neighborhood get to be that way? Why aren't people out here running? Why aren't they taking care of their health? Why aren't they working out in the, you know, the, the park?
[00:23:02] And why aren't there more lights? And why isn't that light on? And why is there trash here? So much judgment. Judgment. But did you know, did you know there is less you know, trash pickup in that area and lower socioeconomic? Did you know that the built environments, there's less green space, there's less upkeep, there's less sidewalk.
[00:23:25] Did you know there's less renovation and upkeep of our parts and recreation and our lower socioeconomic areas? Did you know that there's also increased indoor outdoor. Pollution in our particulates. Did you know that there's less agencies and and and less power balances in those lower socioeconomic areas?
[00:23:48] So parents, parents and families aren't able to say no. Don't put that factory there. That's harmful. No, don't put that pollutant causing you know, vehicle, you know, auto place there. Don't do this. They don't have the voice that certain privileged areas have, they just do not have the same voting power, they don't have the same influence.
[00:24:14] So, a lot of these areas, and don't, you know, I've got to talk about the food deserts, that it's not a plethora of healthy alternatives, there's, you're going to have more fast foods, you're going to have more you know, corner shops that just don't have those fresh foods. So there's a lot of aspect, the nutrition and the environment that are in place and it's not for lack of trying.
[00:24:42] It's not for, you know, people don't care. It's just a lot of things that are stacked up. There's a lot of things that are stacked up against our families. So when we go in there, it's not a matter of, oh, let's look down on them for them, but understanding how things are and the way things are and how it got to be that way.
[00:25:04] Having that knowledge. I think can change the way individuals and, and LPs serve. our communities. 
[00:25:14] Treasyri: Amen, amen. So self awareness, right? And then something you touched on to before I forget it. You talked about this positioning ourselves and we naturally do it, right? I do it. And, you know, you have to be able to check yourself.
[00:25:28] And if you look in the chat, As you were talking, I thought about some tools, right? Because I want this to be highly applicable. I put a link to asha. org under the practice portal and multicultural. They have a list of self reflection tools that you can go through. I do these All the time they have a culturally responsive practice check in that is, and it's just for you.
[00:25:51] It's between you and the, and the, and the man upstairs. They have a gender inclusivity check in and they have a self reflection check in. And then if you're a practice owner, they also have a policies and procedures check in. And then I'm also going to put a link to the Harvard bias test, right? Which I love, which I take all the time.
[00:26:09] My husband thinks I'm, yeah. Cookie, but I think it's so important. It's called the higher Harvard implicit bias association test. And I check in and take it probably once twice a year just to see because your, your biases do change. I have to know. I have to know my blind spots in order to be able to check myself.
[00:26:31] And also in order to be able to have accountability buddies. So I say, well, you know what, I'm really working on this. When you hear me kind of make these comments, please, you know, they always say you have to have, you know, presidents have a cabinet and they say that people, everybody needs to have a kitchen cabinet, right?
[00:26:48] People that you sit around your kitchen table and that will really keep it real with you. Hold you accountable to the, to being your highest self, especially as a practitioner. And so I love that. So you said the first one is self-awareness. And what are the other, the other challenges that you say? 
[00:27:08] Pamela: Complacency and then just lack of knowledge.
[00:27:11] Lack of knowledge of really the origins. Of how, how dynamic culture can be. And I, I think those would be the three, I would definitely say. 
[00:27:23] Treasyri: That's a big one. And, you know, I think what's really interesting to me too, especially with speech pathologists, and I would love to hear your thoughts. I don't think, you know, we're usually speaking.
[00:27:35] Stereotyped as being type A, and I mean, I don't know a speech language pathologist that wakes up and describes himself as complacent. You know what I mean? Like, there are some things that I think are intentional, and then there are some things that are Unintentional and, you know, the cultural complacency, the cultural humility, complacency, it's real.
[00:27:58] But, you know, I see my colleagues, they work so hard right across the board, you know, they have busted their behinds to get through school, busted their behinds to get through their clinicals to get a job to. And so. But yet here, yet we have that. Where do you think that comes from in a profession of people who are really go getters and high achievers, that we still have this complacency when it comes to cultural humility?
[00:28:27] Pamela: I, I, we're so busy. We are so busy and sometimes we can be super microscopic and just focusing just on our little area We're clinical. We were more clinically inclined. When I started the practice and I met with my, my advisor and also the department head she said yeah, you're gonna need to step away from just the clinical view.
[00:28:56] and you're going to have to expand your mind. So the clinical speak and the clinical perspective that we have is very great. It is wonderful when we're working with our patients, but opening our mind and the public health speak is those are two different languages. They really are. It really are two different languages.
[00:29:17] So I like to say that while I am also learning Spanish and I'm a lifelong learner of Spanish, I now am trilingual with public health. So the things I talk about in the perspective that I have and and also, you know, speaking within the realm of public health and how it's all interconnected. It's a total.
[00:29:39] Speak. It really is. for us because we already and so we can easily go i public health. They won't the clinical. 
[00:29:53] Treasyri: Ah, that's where that's another reason we are well positioned, where like you said We are, you know, and like I said, I know I'm biased because I'm a speech pathologist, but we are already primed. If there's anybody who can learn to speak a different language, it's a speech language pathologist, right? 
[00:30:13] Pamela: It really, it really is. That's because we can. Yeah, we're looking narrowly at our populations and how it expands.
[00:30:21] But we can have that pragmatic, you know, duality and, and be able to have that duality of perspective. And so we can shift, we can shift. I do know a lot of SLPs that are considering getting that Second, third, fourth, whatever degree outside of the field of speech pathology in compute community behavioral health global health, public health, health sciences.
[00:30:48] So we, we are very, yes. 
[00:30:51] Treasyri: You know, if my husband wasn't going to divorce me, if I got one more degree, I probably would go back. But I agree. I love, I love seeing a speech pathologist get doctoral degrees outside of speech language pathology. for that. And I think that that's another thing that we don't understand is the value add.
[00:31:12] We, you know, we, I hear speech pathologists talk about how they don't feel appreciated, how they don't real. And I'm thinking in the public health world, if you're a speech language pathologist and you go to a school board meeting and where you go to your community, your city council meeting, and you just, the things that come so easy to you that you talk with, with your patients, if you gave.
[00:31:34] A five minute talk about brain health or a five minute talk about how to promote language in your children or something like that. You know, the level of appreciation and value that you receive from the public health side, from people who are, you know, you'll realize it's almost like dating a guy. And he, he kind of treats you like you're not that attractive.
[00:31:55] And then you go out to a party and everybody is like fawning over you. That's sometimes how it feels, right? And we use. Step out of like, we're SOP, you know, just that track, right? And then you go to like another one when you go out in a public health setting, you think, Oh, what's different about me? And they're like, you're SOP and you're, you're communicating these things.
[00:32:15] So, you know, sometimes you gotta, you gotta break up with that guy and go out to other go out to other avenues. 
[00:32:22] Pamela: Go out to, hey. And I will just let the listeners take from that what they will because that was some gems for your dating life. That's all I'm saying. I won't get into it, but yeah, definitely think outside of the box.
[00:32:35] I, I do find that I, especially in my program where I am alongside epidemiologists. Doctorates of physical therapy, you know, doctor of occupational therapy physiotherapist. When I want to get an easy pass, no lie, this is just a trick of the trade. I'm going to say something speechy and they're like, well, obviously it is.
[00:33:03] That's an A. Automatically. It is. Yeah. It's really cool. It really is cool to be the only speech path in the room or in the in the conference. I went to a conference in in Prague and to be a speech language pathologist and say it and, and hold space and talk about that. It's just, Oh, you're... 
[00:33:24] Treasyri: It is funny.
[00:33:25] And it's nice to be right. And like I said, I love our profession and it's all speech pathology. Right. But, you know, I, I was a joke. I used to live in France. I love France. And one of the reasons I love it is because in France, you know, I'm just like a regular treasure here. But, you know, I'm like a Beyonce in France, right?
[00:33:44] Because I'm American. And so, you know, here I'm just like, Oh, American lady, you know, just another woman in Chicago who can't really parallel park. But when I'm in France, it's like, I'm out again, Beyonce, you know, because I, you know, so sometimes you have to be willy, even though it's a, it's scary to take a step out into these other disciplines and, and really stretch your boundaries.
[00:34:08] Clinical and your foundational prowess and you'll see so my next question I guess for you is what are some practical strategies you just gave one right going out and and be striking out as you know, the only SLP on an interdisciplinary team but what are some other practical strategies that speech language pathologists can use to integrate cultural humility into their public health work.
[00:34:33] Pamela: Absolutely. So, from the I always like to say from the root to the tooth, you know, from the beginning to the end, when you have that first connection with the parents or with the caregiver or with the patient and gathering that case history or having that intake, it starts there. It really starts there.
[00:34:53] Having that inquisitive nature and always just being open, being mindful and just. being open to learn about their experience. What has their experience been thus far? Not being so quick to let me just impart this information, give this test and then move on. Now, all of this is just a mindset. So I'm not saying add an hour onto your evaluation or anything like that.
[00:35:18] But it's just tweaking your mindset and just having that openness to learn more about their culture and asking a quick question. Okay, I'm going to, you know, ask you these questions, you know, let me, let me know at any time if it doesn't feel comfortable. Have you ever been asked these questions before?
[00:35:37] Or just being. Inquisitive. Absolutely having that conversation open. And then also you can incorporate it in your therapy material selection. Right? You can think about if you're working with your swallowing patient, you know, sometimes you always want to go to that applesauce and you want to open it up.
[00:35:56] And, you know, that might not rub some cultures the right way. You know, they might say, Okay. Well, we don't really eat applesauce out of a jar or something. Right, right. We would have maybe some mashed yams or something like that. Incorporate that. Yeah. Flavors incorporate all of those things, or we don't really, you know, give that kind of cold food this time of day.
[00:36:24] It's going to be more of a hot food. You ask those questions and have them bring the food. You tell them what the is incorporate those things incorporated into your sessions and the same thing when we're talking about working with older adults, you know, Do they have certain music that they, music or songs that they like?
[00:36:46] Incorporating all of the things that are relevant to them, that are culturally important to them, incorporating that can be a huge, a huge factor, and it can really increase the buy in into those. 
[00:37:02] Treasyri: Yes. So one thing, so I'm, and as you're talking, like, my brain's going so I'm dropping things, I'm dropping things in the chat for everyone.
[00:37:10] There's there was a great article in the ASHA Leader about ethnographic interviewing within healthcare systems and the constraints, and I'm actually gonna I'm going to drop that in the chat. And you know, the, it makes me think of the ethnographic interview, right? That truly asking the questions in the right ways.
[00:37:28] And so I'm going to drop some of those articles in. You do have access to those articles. You just have to sign into your ASHA account if you are certified. Find your ASHA member. And so they also did one in 2003 talking about strategies for ethnographic interviewing. And so I, that's what you're talking about is right.
[00:37:45] Starting off with that ethnographic interviewing which again, I think we spent one hour on that, one or two hours on that in class in grad school. And I remember doing it once in grad school. And then after that, it was kind of like, You have a million other things to do, baby. You got an 85 percent productivity.
[00:38:06] This is a skilled nursing facility. You got a 30 day research due, you know, you got this IEP meeting that you have these things. And so really that application that, you know, we're almost kind of going back and learning how to apply these things that we know we're in our foundation, but we never really got to see.
[00:38:23] So I love that. Another thing you mentioned too, is about the most. Motivational interview, right? These motivational interview techniques, understanding now really what is driving that person's. Yes. You know, that part, what is there? Why? Right? Like you mentioned, you know, this person, a lot of people if they've been in one cultural environment their whole lives, they've eaten the same thing every day and it's the food of their culture and it's the food that they've had.
[00:38:53] And now all of a sudden they wake up, they've had a fall, they're in your hospital and you bring them a jar of applesauce and then You know, when they don't eat or when they're not motivated, it's like, Oh, they're depressed. Oh, they don't want to participate. Oh, they have a low appetite, but we never even asked them.
[00:39:10] What is, you know, what, what, what do you like? What would you like? What, what do you like to eat? What, what are you into? How can we make that happen? Can maybe we get family to bring food in? Maybe we could, you know, get that creative. And like you said, I think that complacency comes from feeling so incredibly overwhelmed.
[00:39:29] Yeah. So, you know, I, my question for you is, are there any specific tools or resources that you recommend? I know I shared some for SLPs to better understand and address the cultural needs of their clients. 
[00:39:44] Pamela: So the main trigger for and it should be like your spidey senses go up, your, your major like, okay, this is when I need to be culturally attuned and be, give a little bit of edge on it is when you have a human being in front of you.
[00:40:01] Okay, that's that's this it that's the trigger. I've got a human being in front of me. I know this to be true. We're usually a little bit more apt to be to have cultural humility when we hear an accent. Okay, that's just it. It's a signal. It's a signal. When I really need to get my bag out and my, okay, this is a really needed, but that Ethnographic interviewing and that motivational.
[00:40:32] That's for everybody case. I just had a new patient and I still did that. I still did it. You know, tell me how you met and what kind of things were you, you know, I'm going to ask all of those things, but I'm really doing the assessment right at the same time. I'm listening to this. Each I'm hearing to listen to their voice.
[00:40:54] I'm, you know, understanding, okay, this is how their train of thought is going. This is their joint attention. This is the, you know, shifting attention, all of those things. I'm looking at all of those cognitive aspects and speech and fluency, you name it. But I'm still, even though she is. I don't know her ethnicity and she's an elderly Caucasian woman in front of me with, you know, her husband there and they're from the Midwest and, but I'm still needing to know culturally what's going on.
[00:41:26] Absolutely, absolutely. So it made so much. It just, it increases the ability to build rapport. We don't have so much time with our patients, you know, especially if they're in the hospital or if they're at home, you're seeing them for home health. You only have so many visits. So you gotta hit the ground running and that really expert rapport building.
[00:41:52] So they have the buy in so that they can engage and they can get the most out of even the first visit with you. So, When I leave junk visits, no junk minutes, right? No, no, not at all. So making the most making the most out of everything. I, that's what I say. 
[00:42:09] Treasyri: I love it. Thank you. Thank you so much for that.
[00:42:11] And again, I want to remind everyone, our Q and a is open. Our chat is open. I throw things in the chat when Pam drops jewels, so we don't forget them, but please feel free to drop your questions in the chat as well. We're really informal over here. I just called myself the Beyonce of France. So if that doesn't make you feel comfortable with speaking your mind, I don't know what else can.
[00:42:32] So can you talk about the relationship between cultural humility and health equity? 
[00:42:38] Pamela: Absolutely. Absolutely. So when we talk about health, Inequity when there are health disparities that there are, there's one person or one group of people or population that just has a difference of presentation of maybe it's a chronic or non chronic illness or non communicable illness, health equity has to do with access and health outcomes across the board.
[00:43:08] For all people, regardless of their background, their socioeconomic status their region big time, rural versus urban their race, their ethnicity their culture, their background their, their, their ability level or Any of those areas, any, any challenges that they may their neurodiversity, everything, everything, the whole shebang so equity is such a big term.
[00:43:41] And it's such a big, I would say lofty idea. But yeah, it really is just basic human rights, we're talking about over complicated huh. We overcomplicate it, and it seems like, oh, health for everybody. How do we do that? It's just basic human rights. So a lot of the look up U. N. initiatives and you look up preparedness like in September 20th last year, you know, U.
[00:44:08] N. put out, okay, this is the way we're going to address pandemics from now on. It's just basic, basic human rights. And they're saying, this is the, this is the bare minimum minimum. So really when we're talking about health equity, we're talking about LGBTQ TIA, we're talking about all people. We're talking about trans everyone, transgender.
[00:44:41] I could go on and on and on and on elderly. Every population has. the basic human right to health and wellness. 
[00:44:53] Treasyri: Yeah. 
[00:44:54] Speaker 3: Globally. 
[00:44:54] Treasyri: Globally. 
[00:44:55] Pamela: And people are still stuck on it just in their neighborhood. Yeah. But this is globally. 
[00:45:02] Treasyri: Yeah. Globally. Yeah. Globally. Right. And that humility is, like you said, is a mindset.
[00:45:09] It's a mindset. A mindset. A set of beliefs, right? Coming in as a healthcare worker with, you know, you're not, you don't have to change the world. So, just start with believing that everyone deserves to have health and wellness as a bare minimum. 
[00:45:26] Pamela: Forget about your political, I'm gonna say views. Can I say hangups? Yeah. I sometimes it, I can say that we said your Beyonce.
[00:45:35] This is my podcast. I make the rules until we, until we get canceled. Okay. You can do whatever you want. We're, we're telling the truth on here. So the, the situation is everyone, regardless of your upbringing, I'm talking, everyone that's a human being has. The right to health access education, regardless of their gender, regardless of their presentation, whether you believe you agree with it or not.
[00:46:07] No one saying you got to do it or not do it. Everyone. Everybody. Everybody. Everybody. 
[00:46:16] Treasyri: And you know, and thank you so much for saying that. Honestly, we could probably just drop the mic right there and just like play that play that on a loop for the rest of our time. But I think, you know, I would love to hear you talk about how it someone else receiving access to health care.
[00:46:34] Does that harm us? Or does that make our society better? You know, when we talk about public health, I think that there's such a lack of awareness of how other people being healthy around us that are not like us actually makes us more healthy, 
[00:46:50] Pamela: Right. It does. It has to do with education. It has to do with health equity.
[00:46:56] For instance, We are when you get into reading about global health, you're going to see a lot of things with sub Saharan Africa. You see, why are they keep on top? What does that have to do with us? Are you going to hear about health and education initiatives? In red light district in brothels, you're gonna say, what does that have to do with us?
[00:47:21] You're gonna hear about gender education and, and educating women and girls. What does that have to do with us? It has everything to do with us actually in the United States, so. And it sounds cliche to say, but it's true that when one area globally, or even in the United States, if that's all you can say right now, the United States.
[00:47:46] Baby steps, baby steps. In the United States, if one population is having difficulty, it will trickle down to you. And if that's what you need to care about some other population outside of yourself, just know that it's true. Just know that is true. Because the way that policies work, they spread like wildfire.
[00:48:09] They're not contained. They're not contained. And if we think that policies and systems and health policies are not connected, they are most definitely connected. From sea to shining sea. And that's just the way it is. 
[00:48:24] Treasyri: And we have, and just so you know, when we're talking about these things, we do have a reference list.
[00:48:31] One of the things that you're referencing J. R. Bentoncourt writes about that. And I put that reference in the chat because I'm all about receipts. I'm all about receipts, but you can also look on the website too after this to look at the reference list for that when we talk about addressing these disparities, right?
[00:48:47] There is a business case for addressing public health disparities, and there is a public health case for addressing these disparities, right? Because they do trickle down. Trickle down economics might not be a thing like Reagan thought it was, but trickle down public health disparities are definitely a thing.
[00:49:07] And there is, there's definitely something to it. So thank you so much for saying that. And we're going to open it up for questions in a couple of minutes, but I do have you've talked about policy and you are the policy queen you're on the government and public policy committee for in Basler.
[00:49:22] And so. My question for you is what role do public health policies play in supporting or hindering the implementation of cultural humility and clinical practice? 
[00:49:36] Pamela: They, they play a huge amount because the policy, the policy initiators which are The best ones are practitioners, clinicians and practitioners.
[00:49:46] Us. We're the best ones that can be policy policy initiators. But it's everything. So, for instance, Medicaid, I think about Medicaid and I think about how we did have coverage during and this is in florida. But this is in a lot of states as well. We did have that coverage and that expanded coverage during Covid.
[00:50:06] And then we did have When they said, Hey, COVID is no more. And the pandemic is over. Tell that to all the people that are walking around with COVID right now, there is a huge outbreak. But when they took away that coverage and there's lack of access it impacts a lot of areas and it just impacts a lot of individuals.
[00:50:26] So, you know, talking about long term support and services and the push to have even in education, medical services. I would say med medical programs, diversification of our staffing, having more representation and more cultural awareness, cultural humility. All of those policies make a huge difference.
[00:50:51] So there, there's so much to it. There's really a lot. 
[00:50:54] Treasyri: Yeah. And you know. Something you said really just resonated with me, Pam, right? We went to Congress back in May for a Hill Day and I was meeting and we attended a congressional hearing through the Ways and Means Committee on telehealth, right? We know that Before the pandemic, telehealth was in speech pathology was like, ma, they don't, you know, what the Medicare would not reimburse for telehealth.
[00:51:19] They wouldn't cover it. And even though there was all this evidence growing and SLPs were leading the charge saying we, we should be able to provide telehealth until the pandemic, until we had to, they wouldn't cover it. And so now we're in this fight because we know that telehealth works and we know that There are people who are from diverse population from these rural areas from different socioeconomic statuses that do not have access to transportation to get to and from their appointments.
[00:51:51] Do not, you know, cannot do it. And they're usually my from marginalized and minoritized populations. And they, you know, they, it was set to expire December 31st of this year. And so that meant that if the ways and means come come to fruition. Committee and Congress did not do something. Everyone who was receiving teletherapy, speech therapy services was just going to get dropped, right?
[00:52:18] Because they just, December 31st, you're just dropped, right? And what a public health crisis that would have been. And so we attended this committee meeting and there were all types of allied health committees. professionals there and speak some. There were some speech language pathologists there and some ASHA representatives there that testified about the public health crisis, especially for vulnerable communities that would ensue if you just stop providing.
[00:52:46] In these services for people who cannot access them via any other way. And so they ended up extending the telehealth the, the telehealth coverage for Medicare, another two years. But at this point, it's one of those things where it's, why isn't this. Permanent, you know, we know it works. We know that folks benefit from it with the, the, the fraud.
[00:53:12] Concerns are very, very low in terms of Medicare fraud. It's like 0. 0 something percent of fraud cases even have anything to do with telehealth and, you know, you have these people who literally have, have to travel one to two hours. Cause they live in a rural area to get. To a speech language pathologist, or they live on a side of town that there's no public transportation access to where all of the specialty health care is.
[00:53:39] And this teletherapy access is a game changer. And so an understanding that, you know, taking a position of cultural humility and promoting something that again, if telehealth got cut off for me. Whatever. I'll just hop in my vehicle and drive on over. And it's like, Oh, it's a pain. But what does that mean for a different cultural group?
[00:54:00] What does that mean for someone who may be really depends on their care partner to support them because in their house, they do everything together. And because the mother is the matriarch, but maybe she can't leave and having access to that telehealth allows you to be more culturally responsive. So that's an example, I think too, of how policy.
[00:54:20] Public policy can really connect to cultural humility. 
[00:54:24] Pamela: It's just a little bit more. You think that it's just the people that don't have that, you know, don't have access or it's it will trickle down to how people can access. Continuing education. I think we're taking it for granted. The amount of virtual education and international virtual education that has popped up during the pandemic.
[00:54:49] And if you think for a second that the convention and conferences that are out there that they're going to say, Oh, yeah, let's keep on doing virtual. When they can get you to come in person because now that's back to the norm and now you're paying out more money for travel for hotel instead of sitting on your in your, your, your home.
[00:55:14] That's also access. 
[00:55:16] Treasyri: Yeah. 
[00:55:17] Pamela: Also health access, your continuing education, literacy, health, literacy, health, literacy and health promotion and health education. So it affects all of us, not just folks. 
[00:55:30] Treasyri: Yeah, that's true. Olivia says, wow, great point. Yeah, you're wonderful. And so we have about three minutes left.
[00:55:36] So if you have a question speak now forever, hold your peace, please drop it in the chat. And I, you know, I, I want to give you a opportunity. I do this at the end of all of my episodes. This is the second one. So I've only done it once, but I always like to hear about what my guests are reading. What are you reading?
[00:55:58] Right. Because you, you know, I wish I could just, Pick your brain all day, but I can't, but to me, the next best thing is to get an idea. So what are you reading? What are some, what are, are you have any readings or journals that you recommend that listeners check out? 
[00:56:13] Pamela: Yes. I'm always reading my textbooks.
[00:56:15] Okay. So that's just me. I'm, I'm look curriculum development. I was into that, but when it comes to our journals, I'm going to say diversify your journal. So, one thing I get with my I believe it's Sophie Prescription or subscription is the health education and behavior. There's going to be a lot of journal articles, recent You know, up to date evidence based practice and articles regarding all of those areas.
[00:56:42] Cancer, COVID, harm reduction, occupational safety and health, environmental health, you name it, and it's chock full of ideas that are outside of your just, you know, 
[00:56:56] Treasyri: Yeah, our, you know, just stretching ourselves. I love that. Looks like, so we do have a question. Olivia says, what recommendations do you have for getting more involved in public health in our community?
[00:57:08] Pamela: Oh, I love that. I'm definitely you need to join your local chapter. You don't have to be, you know, a public health student or...
[00:57:17] Treasyri: Chapter of what? 
[00:57:18] Pamela: Your local chapter of Sophie and you might have put that in the chat. They have local. So there's the National Society of Public Health Education. There's also the American Public Health Association, but they also have local chapters in your state.
[00:57:34] So you can learn about the issues that are going on in your state. You can also learn about You know, you can also learn about health policy. I believe it's health affairs dot org. They're going to have up to date a lot of information. There are some great websites out there that are talking about things that we just really talk about in our in our field and we don't make time to think about, but you know, 
[00:57:57] Treasyri: But we can get there.
[00:58:00] Like I said, this is how we do it right through sharing knowledge. I'm dropping the links as you talk. We're gonna have to go on instagram live and talk about these resources because this is, I know we...... 
[00:58:11] Pamela: ...kind of, but if you're on linkedin, right, you can curate your timeline to have some of these things in there.
[00:58:16] So linkedin, I've got the American Public Health Association. So I get a lot of those you know, You know, notifications, different things like that. Curate your timeline with individuals that are doing this great work in your area and these associations and you'll hear about it all the time, all the time.
[00:58:33] Treasyri: Thank you. Thank you so much, Pam. And so that is our time. I wanna thank our host, the woman, the Myth, the legend Pamela Rowe for taking time out of her busy, busy schedule to chat with us today. Again, this is our, the ep, a second episode of our mini miniseries. We have a seven episode mini series.
[00:58:57] Thank you for joining. We'll be doing this every single month where we bring these powerhouse guests on to have discussion about. Cultural humility through the lens of something different. So this, this time we're, we talked about public health and I look forward to seeing you next time. Yes, Olivia, we both are on Instagram.
[00:59:18] Pam, you are the public health SLP. 
[00:59:22] Pamela: I am the public health SLP. Why? Because I am the public health, so 
[00:59:29] Treasyri: okay. I'm going to drop mine in there. Pam is the public health. Please feel free to follow us on Instagram and interact with us and have a fantastic evening. Again. My name is Dr. Treasyri Williams Wood and I'm the host of culturally speeching and we will see you next time. 
[00:59:46] Pamela: Thank you. 
[00:59:47] Treasyri: Take care. 
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